Posted on March 03, 2019

The latest developments and challenges involved in providing healthcare to older patients were explained at the Weill Cornell Medicine-Qatar’s (WCM-Q) Grand Rounds.

Dr. Mai Mahmoud, Assistant Professor of Medicine at WCM-Q, identified health issues and common challenges relating to older adults and explained how healthcare providers can use evidence-based practices to create effective care plans.

Dr. Mahmoud, who also holds the positions of Consultant in Internal Medicine and Geriatrics at Hamad Medical Corporation, said that the global population is aging.  According to the WHO, between 2015 and 2050 the proportion of the world’s population aged over 60 will rise from 12 percent to 22 percent. By 2020 there will be more old adults than children aged under 5 years globally, while in the US, it is predicted that adults over 65 will account for more than 50 percent of healthcare visits. Dr. Mahmoud explained that societies and healthcare systems should prepare for rise in the aging population by creating age-friendly environments, both within health institutions and in the wider community. She said: “I am glad to see healthy ageing is a priority in Qatar National Development Strategy 2018-2022.”

WCM-Q Grand Rounds discusses 2 [].jpgExplaining the health challenges faced by older patients, Dr. Mahmoud said: “With age, the organs of the body lose their physiological reserve of cells, which function somewhat like spare parts that allow each organ to maintain its function during an insult like an illness. Also, there are more medical conditions like diabetes, hypertension, and arthritis that require medications, so we often have the additional issue of polypharmacy and the side-effects of medications to consider. All these challenges make older patients more vulnerable to severe diseases and complications when compared to younger population.” Dr. Mahmoud noted that these changes are not linear; some older patients remain highly active while some are partially or totally dependent on others.

Dr. Mahmoud, who is also Director for Student Academic Advising and Director of the Medicine Clerkship at WCM-Q, is a graduate of the Faculty of Medicine at the University of Khartoum. She took her residency training at the State University of New York, Brooklyn, before going on to complete a fellowship in geriatric medicine at St. Luke’s-Roosevelt Hospital Center (University Hospital of Columbia University College of Physicians and Surgeons). Dr. Mahmoud recently completed a Master’s in Education for the Health Professions (MEHP) from Johns Hopkins University. She has published research in the fields of geriatric osteoporosis, diabetes mellitus, shisha smoking, and medical education.

Dr. Mahmoud explained the risk posed to older patients by falls, which are the leading cause of non-fatal injuries in patients aged over 65. Complications following falls, such as fractures and problems arising from surgeries, are also a common cause of death among older patients. Older patients most at risk of falls are those with dementia, poor vision, osteoarthritis, general frailty, sarcopenia (loss of muscle mass), cardiovascular disease, central nervous system diseases and complications from diabetes mellitus and certain prescription drugs, she said. Dr. Mahmoud said that it is important for healthcare professionals to assess older patients’ risk of falls and work with them to reduce this risk.

Other issues older patients often face include urinary incontinence, specific age-related recommendations for treatment of hypertension and diabetes, and health problems caused by hospitalization, including delirium (acute disorientation and confusion), often caused by being in an unfamiliar setting, such as a hospital.

To mitigate these issues, healthcare practitioners must understand the health issues of the hospitalized older patients in a holistic manner, conduct frequent patient evaluations, manage medications extremely carefully, be patient, give clear and simple instructions, and assess the patient’s mental state as often as possible. Also, healthcare professionals should be aware of the American Geriatrics Society’s Beers Criteria (named after Mark Beers MD) for drugs that should be avoided in older patient. Older adults should also receive vaccines and screening as recommended.

Despite the challenges presented by aging, Dr. Mahmoud stressed the importance of refraining from pre-judging older patients, pointing out that many older people continue to be productive, socially engaged, physically active and artistically creative in their later years. The activity was accredited locally by the Qatar Council for Healthcare Practitioners-Accreditation Department (QCHP-AD) and internationally by the Accreditation Council for Continuing Medical Education (ACCME).